An increasing trend in geriatric trauma patients undergoing surgical stabilization of rib fractures

Abstract

Purpose The proportion of geriatric trauma patients (GTPs) (age ≥ 65 years old) with chest wall injury undergoing surgical stabilization of rib fractures (SSRF) nationally is unknown. We hypothesize a growing trend of GTPs undergoing SSRF, and sought to evaluate risk of respiratory complications and mortality for GTPs compared to younger adults (18–64 years old) undergoing SSRF. Methods The Trauma Quality Improvement Program (2010–2016) was queried for patients with rib fracture(s) who underwent SSRF. GTPs were compared to younger adults. A multivariable logistic regression analysis was performed. Results From 21,517 patients undergoing SSRF, 3,001 (16.2%) were GTPs. Of all patients undergoing SSRF in 2010, 10.6% occurred on GTPs increasing to 17.9% in 2016 ( p < 0.001) with a geometric-mean-annual increase of 11.5%. GTPs had a lower median injury severity score (18 vs. 22, p < 0.001), but had a higher rate of mortality (4.7% vs. 1.2%, p < 0.001). After controlling for covariates, GTPs had an increased associated risk of mortality (OR 4.80, CI 3.62–6.36, p < 0.001). On a separate multivariate analysis for all trauma patients with isolated chest Abbreviated Injury Scale 3, GTPs were associated with a similar four-fold risk of mortality (OR 4.21, CI 1.98–6.32, p < 0.001). Conclusion Spanning 7 years of data, the proportion of GTPs undergoing SSRF increased by over 7%. Although GTPs undergoing SSRF had lesser injuries, their risk of mortality was four times higher than other adult trauma patients undergoing SSRF, which was similar to their increased background risk of mortality. Ultimately, SSRF in GTPs should be considered on an individualized basis with careful attention to risk–benefit ratio. Electronic supplementary material The online version of this article (10.1007/s00068-020-01526-7) contains supplementary material, which is available to authorized users.

Rib fractures in the elderly population: a systematic review

“…Conservative treatment consisting of (non)invasive ventilation, pain management and physiotherapy, has long been considered the gold standard for the management of rib fractures [ 4 , 5 ]. Since the development of multiple plating and rib fixation systems, there has been a growing interest in operative treatment, also for elderly patients with rib fractures [ 6 , 7 ]. General indications for operative treatment of rib fractures include, flail chest segment, reduction of pain and disability, chest wall deformity, thoracotomy and open rib fractures [ 8 ].…”

Surgical Rib Fixation in Obese Patients with Isolated Flail Chest Improves Outcomes: A Matched Cohort Study

“…Despite a recent increase in popularity [12, 14], surgical rib fixation in flail chest remains controversial. While multiple studies have evaluated outcomes and indications for fixation, the conclusions have not been consistent and no randomized controlled trial has shown a true mortality benefit with surgical rib fixation in patients with isolated flail chest.…”

“…While surgical RF has demonstrated improved patient outcomes in recent studies [7,[11][12][13][14][15][16][17][18][19][20], questions regarding the benefit in the obese trauma patient have remained unanswered. To our knowledge, this is the first study to specifically evaluate outcomes in obese patients undergoing RF for flail chest.…”

“…Additionally, there appears to be a benefit in performing early RF in these vulnerable patients, with those undergoing early rib fixation (\ 3 days) having decreased odds of prolonged mechanical ventilation and ICU LOS. Despite a recent increase in popularity [12,14], surgical rib fixation in flail chest remains controversial. While multiple studies have evaluated outcomes and indications for fixation, the conclusions have not been consistent and no randomized controlled trial has shown a true mortality benefit with surgical rib fixation in patients with isolated flail chest.…”

“…While the results for RF in patients with concomitant rib fractures and TBI are encouraging [18], the data regarding RF in the geriatric population is conflicting. [11, 14].…”